Multiple Complications Due to Subacute Suppurative Otitis Media

Qirjazi, Brikena; Bardhyli, Dolores; Hoxhallari, Xhevair

doi:10.5152/balkanmedj.2012.021

Cited by 1 publication

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“…However, there are very few cases in the literature regarding multiple complications occurring concomitantly in the same case [3][4][5] . For instance, Berçin et al [5] reported a case with facial nerve paralysis, lateral sinus thrombosis, and sensorineural hearing loss, Qirjazi et al [3] discussed a case with facial palsy and serous labryrinthitis due to subacute otitis media, and Saffer et al [6] reported a seven-year-old boy with lateral sinus thrombosis and cervical abscess secondary to cholesteatoma.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous Coexistence of Complications of Chronic Otitis Media in the Same Case

Toros¹,

Karaca²,

Ertugay³

et al. 2017

Int Adv Otol

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INTRODUCTIONBroad use of more effective and stronger antibiotics resulted in a decline in the incidence of chronic otitis media (COM) complications; however, the significance of complications has remained stable due to high mortality and morbidity rates [1]. Simultaneous coexistence of complications of COM in the same case is a rare situation, and the present report describes a case of multiple complications of COM. CASE PRESENTATIONA 45-year-old man attended to our emergency department complaining of left otalgia, purulent otorrhea, and pain in the left cervical area with a 15-day history. After consultation to our clinic, the patient was hospitalized with the diagnosis of left COM, mastoiditis, and Bezold abscess and treated ambulatorily with broad-spectrum intravenous antibiotics (tazobactam-piperacillin, teicoplanin, and clindamycin). He complained of hearing loss, frequent ear discharges, and otalgia in left ear of 10-year duration. He smoked cigarets and used alcohol; additionally, he had a history of hospitalization with a diagnosis of meningitis at a different otorhinolaryngology department seven years ago.Otoscopic evaluation showed swelling of the external ear and a foul-smelling purulent discharge in the left ear. Bezold abscess was drained under local anesthesia. Abscess and blood culture were taken. The general condition of the patient was normal initially, but after 24 hours of treatment, he had nausea and vomiting, then his general condition deteriorated. Neck stiffness and positive Kernig's sign were determined in physical examination. We performed a computerized tomography (CT) scan, magnetic resonance imaging (MRI), and lumbar puncture to exclude cranial involvement, and these tests confirmed a left middle ear cholesteatoma associated with ipsilateral lateral sinus thrombophlebitis and meningitis (Figure 1). Therefore, the patient was sent to intensive care unit, and treatment changed to meropenem, and vancomycin, metronidazole, which were more specific antimicrobial agents to treat a cranial nervous system infection.Under these circumstances, we performed radical mastoidectomy. The mastoid cavity, middle ear cavity, and perisinusoidal air cells were filled with cholesteatoma debris. There was bone erosion in the perisinusoidal region (Figure 2). Streptococcus constellatus was iso- Simultaneous Coexistence of Complications of Chronic Otitis Media in the Same CaseChronic otitis media (COM) is a common clinical entity, but the incidence of COM complications has declined recently due to broad use of antibiotics. Independent of this, these complications are still a significant challenge in otorhinolaryngology practice because of high morbidity and mortality rates. The most common etiologic diagnosis was cholesteatomatous COM. Simultaneous coexistence of complications of COM in the same case is a rare situation, and the present report describes a case with mastoiditis, Bezold abscess, lateral sinus thrombophlebitis, meningitis, and paraspinal abscess.

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